Articles: intensive-care-units.
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An audit of 265 intensive care unit (ICU) admissions from the operating room was performed for the year 1991. In a quality assurance exercise we identified 34 unanticipated ICU admissions (UIAs) by a retrospective peer review of the medical charts. Of these UIAs, 16 were deemed predictable and seven preventable. ⋯ ICU-specific interventions were not initially required in 36% of admissions and these patients had a low risk (1.1%) of eventually requiring ICU-specific interventions. In comparison with patients requiring ICU-specific interventions, they had lower Apache II scores (10.2 vs 13.1), shorter ICU stays (medians of one vs two days), lower ICU mortality (0 vs 8.2%), P < 0.05, but hospital mortality was not different (7.4 vs 15.3%). This audit has prompted reorganisation of our intensive care services, so that patients not requiring ICU-specific interventions will be managed in an intermediate care area with nurse:patient ratios of 1:3 or 4, in comparison with 1:1 or 2 ratios in the intensive care area.
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Critical care medicine · Feb 1993
Comparative StudyPreoperative intensive care unit consultations: accurate and effective.
To determine if a structured preoperative ICU consultation would correctly assign patients to preoperative invasive monitoring, postoperative ICU care, or recovery room care, and to compare morbidity, mortality, and resource utilization among all groups. ⋯ A small number of high-risk patients can be selected for preoperative monitoring on the basis of clinical assessment without increasing ICU stay or hospital bills. A structured preoperative consultation correctly identifies those patients who need monitoring and ICU care, but does not overutilize scarce and expensive ICU beds.
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The intensive care unit provides multisystem support and therapy to critically ill patients, and represents an expensive part of hospital medicine. This survey validates the use of APACHE II as a severity scoring system that allows reliable prediction of outcome of intensive care patients in Singapore. ⋯ Patients with sepsis fared poorer than expected from their APACHE II scores, and stroke patients needing intensive care admission had an extremely poor prognosis (mortality rate of 85.7%). High APACHE II scores are associated with invasive haemodynamic monitoring.
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The working practices and outcomes from UK intensive care units are poorly documented to date. We have reviewed 2000 consecutive admissions to one intensive care unit in a tertiary referral centre with initially six, then eight beds. The study was a retrospective review of contemporaneous data collection within the period 1986-1990. ⋯ The report illustrates some of the advantages and disadvantages of one method of data collection. As it represents one unit only, care must be taken in extrapolating results to others. The timing of admissions suggests that a review of medical staffing practices would be useful.
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Ugeskrift for laeger · Jan 1993
[Description of activities in the neonatal department at Rigshospitalet during the period 1983-1990].
Since 1983, the gestational age (GA in completed weeks), use of mechanical ventilation, duration of hospitalization and the diagnosis-related group were registered routinely for all infants admitted to the Neonatal Department, Rigshospitalet, Copenhagen. The data were analysed concerning the 6,636 infants treated during the seven-year period until the end of 1991. The annual number of admissions decreased during the period (p < 0.001) whereas the number of extremely preterm infants (GA < 28 weeks) increased from 30 to 45 annually (p < 0.05). ⋯ The cost of treatment increased by 40% in fixed prices to DDK 4,000 per day (approximately 333 pounds). The authors conclude that the introduction of nasal continuous positive airway pressure (CPAP) has permitted treatment of moderately preterm infants in county hospitals and has also resulted in avoidance of mechanical ventilation in extremely preterm infants without preventing improved survival. Although the patients have become more selected, the duration of hospitalization remains unchanged.